|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 72888001401
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.60
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: UHC Exchange |
$20.32
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 51079064420
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.04 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.44
|
| Rate for Payer: UHC Core |
$131.01
|
| Rate for Payer: UHC Exchange |
$98.82
|
| Rate for Payer: UMR Bronson Commercial |
$93.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 69097084607
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 50268019111
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 51079064420
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.64 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UMR Bronson Commercial |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
NDC 50268019115
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Aetna American Axle |
$109.98
|
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna Medicare |
$84.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.98
|
| Rate for Payer: BCBS Complete |
$67.68
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Advantage |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.90
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health SBD |
$106.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.98
|
| Rate for Payer: UHC Core |
$88.15
|
| Rate for Payer: UHC Exchange |
$66.50
|
| Rate for Payer: UMR Bronson Commercial |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.90
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 72888001401
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 59746021106
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 59746021106
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.24
|
| Rate for Payer: UHC Core |
$188.55
|
| Rate for Payer: UHC Exchange |
$142.23
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 10702000601
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 69097084507
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Advantage |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 69097084507
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$42.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Advantage |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.99
|
| Rate for Payer: UHC Core |
$44.08
|
| Rate for Payer: UHC Exchange |
$33.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 72888001201
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 72888001201
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.41
|
| Rate for Payer: UHC Core |
$40.40
|
| Rate for Payer: UHC Exchange |
$30.48
|
| Rate for Payer: UMR Bronson Commercial |
$28.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
CYCLOBENZAPRINE 5 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 10702000601
|
| Hospital Charge Code |
35184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.21
|
| Rate for Payer: UHC Core |
$53.87
|
| Rate for Payer: UHC Exchange |
$40.64
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna American Axle |
$26.16
|
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: UMR Bronson Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna American Axle |
$11.03
|
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.03
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Advantage |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: Priority Health SBD |
$10.69
|
| Rate for Payer: UMR Bronson Commercial |
$7.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna American Axle |
$26.16
|
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.16
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: UHC Exchange |
$15.82
|
| Rate for Payer: UMR Bronson Commercial |
$14.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna American Axle |
$12.26
|
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Advantage |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.26
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: UHC Exchange |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$6.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna American Axle |
$12.26
|
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Advantage |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: UMR Bronson Commercial |
$8.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna American Axle |
$11.03
|
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.03
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Advantage |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: Priority Health SBD |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.03
|
| Rate for Payer: UHC Core |
$8.84
|
| Rate for Payer: UHC Exchange |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
OP
|
$202.06
|
|
|
Service Code
|
NDC 00065035905
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$181.85 |
| Rate for Payer: Aetna American Axle |
$131.34
|
| Rate for Payer: Aetna Commercial |
$171.75
|
| Rate for Payer: Aetna Medicare |
$101.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.34
|
| Rate for Payer: BCBS Complete |
$80.82
|
| Rate for Payer: Cash Price |
$161.65
|
| Rate for Payer: Cofinity Advantage |
$141.44
|
| Rate for Payer: Cofinity Commercial |
$173.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.65
|
| Rate for Payer: Healthscope Commercial |
$181.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.54
|
| Rate for Payer: PHP Commercial |
$171.75
|
| Rate for Payer: Priority Health SBD |
$127.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.34
|
| Rate for Payer: UHC Core |
$105.27
|
| Rate for Payer: UHC Exchange |
$79.41
|
| Rate for Payer: UMR Bronson Commercial |
$74.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.54
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
OP
|
$114.98
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$103.48 |
| Rate for Payer: Aetna American Axle |
$74.74
|
| Rate for Payer: Aetna Commercial |
$97.73
|
| Rate for Payer: Aetna Medicare |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.74
|
| Rate for Payer: BCBS Complete |
$45.99
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cofinity Advantage |
$80.49
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.98
|
| Rate for Payer: Healthscope Commercial |
$103.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.23
|
| Rate for Payer: PHP Commercial |
$97.73
|
| Rate for Payer: Priority Health SBD |
$72.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.74
|
| Rate for Payer: UHC Core |
$59.90
|
| Rate for Payer: UHC Exchange |
$45.19
|
| Rate for Payer: UMR Bronson Commercial |
$42.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.23
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
IP
|
$202.06
|
|
|
Service Code
|
NDC 00065035905
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$181.85 |
| Rate for Payer: Aetna American Axle |
$131.34
|
| Rate for Payer: Aetna Commercial |
$171.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.34
|
| Rate for Payer: Cash Price |
$161.65
|
| Rate for Payer: Cofinity Advantage |
$141.44
|
| Rate for Payer: Cofinity Commercial |
$173.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.65
|
| Rate for Payer: Healthscope Commercial |
$181.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.54
|
| Rate for Payer: PHP Commercial |
$171.75
|
| Rate for Payer: Priority Health SBD |
$127.30
|
| Rate for Payer: UMR Bronson Commercial |
$88.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.54
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
IP
|
$114.98
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.59 |
| Max. Negotiated Rate |
$103.48 |
| Rate for Payer: Aetna American Axle |
$74.74
|
| Rate for Payer: Aetna Commercial |
$97.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.74
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cofinity Advantage |
$80.49
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.98
|
| Rate for Payer: Healthscope Commercial |
$103.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.23
|
| Rate for Payer: PHP Commercial |
$97.73
|
| Rate for Payer: Priority Health SBD |
$72.44
|
| Rate for Payer: UMR Bronson Commercial |
$50.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.23
|
|
